Arrangements for adult service users
who are homeless in English mental
Steven Lucas, Philip John Archard, James Tangen and David Murphy
Purpose –The purpose of this paper is to report an analysis of arrangements in English mental health trusts
to meet the needs of adult service users who are homeless. Homelessness is associated with various forms
of mental ill-health, yet homeless people are not always well-served by statutory mental health services.
In recent years, practice guidance seeking to improve health outcomes for the homeless has emphasised the
need for NHS services to improve care pathways and professional provision for this service user group, in
part by collaborating more closely with homelessness organisations.
Design/methodology/approach –Responses to freedom of information requests sent to trusts were
analysed. The requests asked trusts for information concerning partnerships with external agencies,
particular projects/staff, training available to trust professionals, referral pathways, and intervention models/
approaches informing work with homeless service users.
Findings –In total, 49 trusts provided information that could be used in the analysis. Just under half of these
had dedicated arrangements or resources, including outreach teams and clinical staff co-located in
accommodation and support services for the homeless. The remaining trusts indicated that they either had
some limited specific arrangements, such as links between local agencies working with the homeless and
existing services, or no dedicated arrangements in place. Training to improve staff awareness around, and
knowledge in, working with homeless service users tended to be minimal if provided at all.
Originality/value –This analysis further evidencesgaps in the way the needs of the homeless population are
addressed by statutory mental health services and adds support to concerns about the homeless having
equitable access to care and treatment.
Keywords Outreach, Freedom of information, Homelessness, Partnership working, Staffing/resources
Paper type Research paper
This paper reports an analysis of arrangements in English mental health trusts to meet the needs
of adult service users who are homeless.
The link between homelessness and poor mental health is well-recognised. The prevalence of mental
health problems is disproportionately high in the homeless population, with increased rates of
depression, anxiety, schizophrenia, personality disorders, self-harm and attempted suicide (Fazel et
al., 2008; Folsom and Jeste, 2002; McGilloway and Donnelly, 2001; Sims and Victor, 1999; Sundin
and Baguley, 2015). However, homeless people are not always well-served by mental health services.
Various factors contribute to this state of affairs (see Bhui et al., 2006; Bines, 1994; Crane and
Warnes, 2001; Rae and Rees, 2015; Taylor, 2012; Williams and Stickley, 2011, for overviews).
The extent to which homeless people’s social and medical needs are intertwined makes it difficult
to assign responsibility for care to one professional group over another. Because of more
pressing practical concerns, homeless people can fail to prioritise their healthcare needs and not
seek help until urgent or emergency care is required. Difficulties in registering with a general
practitioner and accessing primary care services can impede navigating initial treatment and
onward referral to secondary care and specialist services. Homeless people can also fall
between alcohol/substance misuse and mental health services, with unmet needs that reside
Received 7 April 2017
Revised 11 October 2017
Accepted 7 November 2017
This research received no specific
grant from any funding agency in
the public, commercial or not-for-
Steven Lucas is a Lecturer in
Social Work at the School of
Social Science, Liverpool Hope
University, Liverpool, UK.
Philip John Archard is a PhD
Student at the School of
Sociology and Social Policy,
University of Nottingham,
James Tangen is a Lecturer in
Criminology at the School of
Applied Social Sciences,
De Montfort University,
David Murphy is anAssociate
Professorat the School of
Nottingham, Nottingham, UK.
PAG E 64
MENTALHEALTH REVIEW JOURNAL
VOL. 23 NO. 1 2018, pp. 64-71, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-03-2017-0017